HomeMy WebLinkAboutPRR21031 MetroReporting - 12-27-20 LOVR incidentSASE,
!PLEASE RETURN THIS PORTION WITH REQUEST!
Account No. 06363 SGD-CA VM
Questions? Contact Metro's CALIFORNIA DEPARTMENT
Please Reply To:
Metropolitan Reporting Bureau
Box 926, William Penn Annex
Philadelphia, PA 19105-0926
Phone: (800) 245-6686
Fax No: (800) 343-9047
www.metroreporting.com
Email: report®metroreporting.com
Request for a(n) FIRE
REPORT NUMBER
INSURED
DATE OF LOSS
LOCATION
DRIVER
OTHER DRIVER
CLAIM NUMBER
WE REPRESENT Schifrin, Gagnon And Dickey
As agent for the above insurance company
Report. Please return this form with report.
20-1.227061
THE MUDDY CUP
12/27/20
12300 LOS OSOS VALLEY ROAD
SAN LUIS OBI CA
F-01M
DOB:
SO409192
VEHICLE YEAR
MAKE/MODEL
DRIVER LICENSE#
VIN#
STATE
PLATE/TAG#
POLICE DEPARTMENT: SAN LUIS OBISPO FIRE DEPT.
BARRACKS/PCT.#
DESCRIPTION CHRISTMAS LIGHTS FIRE
CHRISTMAS LIGHTS FIRE
POLICY##: CMP005066-01
!PLEASE RETURN THE BOTTOM PORTION WITH REQUEST!
0 Unable to Locate Report With Information Given
0 Loss Location Not In Our Jurisdiction. Try:
Log Entry Only, No Report Written. Please attach call sheet.
O Not Releasable Not Ready Reason: